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Prophylaxis after exposure to Coxiella burnetii.

Moodie CE, Thompson HA, Meltzer MI, Swerdlow DL - Emerging Infect. Dis. (2008)

Bottom Line: We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted.PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy.PEP would begin 8-12 days postexposure.

View Article: PubMed Central - PubMed

Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. claire_moodie@hotmail.com

ABSTRACT
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy. PEP would begin 8-12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug-related adverse events when the probability of C. burnetii exposure is >or=7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).

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Decision tree for a general population of 100,000 based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 100 mg doxycycline 2×/d for 5 d, assuming 82% drug efficacy and 100% exposure). PEP-related adverse events are not included in this figure. The probability of each individual event occurring is provided in the decision tree under the respective event title (i.e., 1.00 for Exposure). Some events list a range of probabilities with the specific probability for this scenario in parentheses (i.e., “0.82–0.965 (0.82)” for “PEP No illness”). The number of persons with each respective outcome is listed on the right side of the tree. A summary of outcomes (total illness, severe illness and death) and the percentage of the population with such an outcome are provided in the table below the PEP and “No PEP” trees. We defined total illness as all acute illness, severe illness, and Q fever–related deaths. Severe illness was defined as hospitalization during acute infection, chronic illness, Q fever fatigue syndrome (QFS), or death. This description also applies to Figures 2 and 3.
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Figure 1: Decision tree for a general population of 100,000 based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 100 mg doxycycline 2×/d for 5 d, assuming 82% drug efficacy and 100% exposure). PEP-related adverse events are not included in this figure. The probability of each individual event occurring is provided in the decision tree under the respective event title (i.e., 1.00 for Exposure). Some events list a range of probabilities with the specific probability for this scenario in parentheses (i.e., “0.82–0.965 (0.82)” for “PEP No illness”). The number of persons with each respective outcome is listed on the right side of the tree. A summary of outcomes (total illness, severe illness and death) and the percentage of the population with such an outcome are provided in the table below the PEP and “No PEP” trees. We defined total illness as all acute illness, severe illness, and Q fever–related deaths. Severe illness was defined as hospitalization during acute infection, chronic illness, Q fever fatigue syndrome (QFS), or death. This description also applies to Figures 2 and 3.

Mentions: To calculate adverse outcomes with and without PEP, we constructed a decision tree for each target group illustrating all possible outcomes after exposure to C. burnetii. The general population and high-risk populations share the same tree structure (Figures 1, 2); the tree for pregnant women incorporates the outcomes for the unborn child (Figure 3). Drug-related side effects are not included in Figures 1–3; however, the number of side effects was calculated per Equation 4 in the Technical Appendix. Total medical cases averted were calculated at 4 arbitrary levels of C. burnetii exposure (100%, 50%, 25%, and 10%).


Prophylaxis after exposure to Coxiella burnetii.

Moodie CE, Thompson HA, Meltzer MI, Swerdlow DL - Emerging Infect. Dis. (2008)

Decision tree for a general population of 100,000 based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 100 mg doxycycline 2×/d for 5 d, assuming 82% drug efficacy and 100% exposure). PEP-related adverse events are not included in this figure. The probability of each individual event occurring is provided in the decision tree under the respective event title (i.e., 1.00 for Exposure). Some events list a range of probabilities with the specific probability for this scenario in parentheses (i.e., “0.82–0.965 (0.82)” for “PEP No illness”). The number of persons with each respective outcome is listed on the right side of the tree. A summary of outcomes (total illness, severe illness and death) and the percentage of the population with such an outcome are provided in the table below the PEP and “No PEP” trees. We defined total illness as all acute illness, severe illness, and Q fever–related deaths. Severe illness was defined as hospitalization during acute infection, chronic illness, Q fever fatigue syndrome (QFS), or death. This description also applies to Figures 2 and 3.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2609859&req=5

Figure 1: Decision tree for a general population of 100,000 based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 100 mg doxycycline 2×/d for 5 d, assuming 82% drug efficacy and 100% exposure). PEP-related adverse events are not included in this figure. The probability of each individual event occurring is provided in the decision tree under the respective event title (i.e., 1.00 for Exposure). Some events list a range of probabilities with the specific probability for this scenario in parentheses (i.e., “0.82–0.965 (0.82)” for “PEP No illness”). The number of persons with each respective outcome is listed on the right side of the tree. A summary of outcomes (total illness, severe illness and death) and the percentage of the population with such an outcome are provided in the table below the PEP and “No PEP” trees. We defined total illness as all acute illness, severe illness, and Q fever–related deaths. Severe illness was defined as hospitalization during acute infection, chronic illness, Q fever fatigue syndrome (QFS), or death. This description also applies to Figures 2 and 3.
Mentions: To calculate adverse outcomes with and without PEP, we constructed a decision tree for each target group illustrating all possible outcomes after exposure to C. burnetii. The general population and high-risk populations share the same tree structure (Figures 1, 2); the tree for pregnant women incorporates the outcomes for the unborn child (Figure 3). Drug-related side effects are not included in Figures 1–3; however, the number of side effects was calculated per Equation 4 in the Technical Appendix. Total medical cases averted were calculated at 4 arbitrary levels of C. burnetii exposure (100%, 50%, 25%, and 10%).

Bottom Line: We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted.PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy.PEP would begin 8-12 days postexposure.

View Article: PubMed Central - PubMed

Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. claire_moodie@hotmail.com

ABSTRACT
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy. PEP would begin 8-12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug-related adverse events when the probability of C. burnetii exposure is >or=7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).

Show MeSH
Related in: MedlinePlus